Healthcare Provider Details

I. General information

NPI: 1134941727
Provider Name (Legal Business Name): JANICE MOSELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 FIVE POINTS RD SW
ALBUQUERQUE NM
87105-3179
US

IV. Provider business mailing address

1528 FIVE POINTS RD SW
ALBUQUERQUE NM
87105-3179
US

V. Phone/Fax

Practice location:
  • Phone: 505-588-7438
  • Fax: 505-717-2498
Mailing address:
  • Phone: 505-615-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29307
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: